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Group Health Insurance Quote Form
 
 

Attracting and retaining good employees is important to the success of any business. A group medical plan for your employees is imperative in today's competitive marketplace. There are several types of plans to choose from and you can even offer dual option or triple option plans where you can offer more than one plan for your employees to choose from.

HMO (Health Maintenance Organization) - Requires you to obtain medical care from a specified list of hospitals and doctors. You must choose a PCP (Primary Care Physician) and you need a referral from your PCP to see Specialists. Out of network expenses are not covered.

POS (Point-of-Service) - Also requires you to obtain medical care from a specified list of hospitals and doctors as well as Primary Care Physicians. However, you also have the option to obtain care from non-network doctors and hospitals. When your expenses are from out-of-network providers, you will have to pay more of the cost.

PPO (Preferred Provider Organization) - Allows you to use specified in-network hospitals and doctors, but you can also use out of network hospitals and doctors who are not members of the PPO network. If you are seen by PPO providers, your benefit will be at a higher return than if you were seen by an out of network provider. Unlike a POS, you do not have to choose a PCP (Primary Care Physician) in order to receive In Network benefits.
General Information
Company Name:
Contact Person:
Nature of Business:
Street Address:
City:
State:
Zip:
Phone Number:
Fax:
E-mail Address:
Coverage Information
Total Number of Full-Time Employees:
Number Eligible for Coverage:
Which features do you want in your plan (deductibles, copays, dental etc.):
What company do you have your health plan with now ?
Employee Information
Employee #1 Name:
Gender: Birthrate: / / Cover:
Employee #2 Name:
Gender: Birthrate: / / Cover:
Employee #3 Name:
Gender: Birthrate: / / Cover:
Employee #4 Name:
Gender: Birthrate: / / Cover:
Employee #5 Name:
Gender: Birthrate: / / Cover:
Employee #6 Name:
Gender: Birthrate: / / Cover:
Employee #7 Name:
Gender: Birthrate: / / Cover:
Employee #8 Name:
Gender: Birthrate: / / Cover:
Employee #9 Name:
Gender: Birthrate: / / Cover:
Select Health Plans and Options
Please select the type of plans and options you would like to receive quotes on
  Plans Options
  HMO Maternity
  POS Prescription
  POP Dental
    Vision Care

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Why it pays to let LM Financial help you find
the best, most affordable health insurance
  • We will contact you promptly.
  • We will never sell your personal information to anyone.
  • Our computerized quote database accurately determines the coverage you qualify for.
  • You will get quotes from several highly-rated insurance companies, to make sure you get the best coverage at the best price.
  • We will assist you in getting your life insurance policy issued quickly and efficiently.We are committed to providing excellent customer service and the best term life insurance.
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